MADRID, SPAIN (UroToday.com) - Comprehensive assessment of perioperative outcomes aids in identifying areas for improvement and allows for appraisal over time of the impact of surgical and management modifications aimed at reducing complications. This study presented 90-day complications following radical cystectomy recorded in a prospectively-collected national population-based cystectomy registry from Sweden. This registry captured over 1 000 cystectomies between 2011-2013, which represented 76% of those performed in the country during that time period. The rate of capture increased over the 3-year time period, from 72% in 2011 to 79% in 2013. The authors noted that 36% of patients with clinical stage T2 disease or higher underwent neoadjuvant chemotherapy.
The study found that utilization of robotic cystectomy increased from 6% in 2011 to 28% in 2013. Incontinent diversion was utilized in the vast majority (85%). Median hospital length of stay was 14 days and an unscheduled readmission rate of 25% was observed. Over 40% of patients required a transfusion, higher with open surgery than robotic surgery (50% vs. 14%, respectively).
The authors reported that the overall complication rate over the time period was 47%, with 21% of patients experiencing a complication with Clavien grade 3 or higher. The most common type of complication reported was infectious (26%), followed by abdominal wall/stoma (11%), and gastrointestinal (8%). The authors reported that complication rates did not differ between open and robotic cystectomy groups. Reoperations occurred in 12%. Disease-related mortality within 90 days was 1.6%. An additional 3.5% of patients died within 90 days of surgery of causes unrelated to their cancer which the authors hypothesized could potentially be attributed to surgery-specific causes.
This comprehensive report of the complications experienced within 90 days of a large portion of the cystectomies performed in Sweden over the course of 3 years highlights the fact that radical cystectomy remains a surgery that carries a high risk for morbidity. Further examination of the specific complications which are most common, as well as the use of perioperative risk assessment tools to identify patients most likely to experience those complications, may help to decrease the high morbidity associated with cystectomy.
Presented by Tomas Jerlström1 and Oskar Hagberg2 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
1Department of Urology, Örebro University Hospital, School of Health and Medical Sciences, Örebro University, Sweden; 2Regional Cancer Center South, Lund, Sweden; On behalf of the steering committee of the Swedish Cystectomy registry
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Reported by Timothy Ito, MD, medical writer for UroToday.com